High Cholesterol and Lipoprotein(a) or Lp(a) AKA Lp little a
What is cholesterol?
Cholesterol is an essential part of the human body. It is found in all parts of the body, and it is specifically used to coat nerves, produce cell walls, and create hormones. Your liver produces the vast majority of your cholesterol that your body needs. You can also get cholesterol directly from the food you eat (such as eggs, meats and dairy products). Cholesterol is a vital part of life, but it is important to keep it at the appropriate levels. Too much cholesterol causes negative health consequences.
Why is my cholesterol level important to me?
When cholesterol levels are too high, the cholesterol molecules begin depositing throughout your body in all of its blood vessels. All blood vessels are affected, including the blood vessels around your heart, brain, kidneys, eyes, etc. Every person is different, and each person deposits cholesterol in different areas. Poorly controlled elevated cholesterol levels can lead to early heart attacks, strokes, kidney disease (which leads to dialysis), and poor circulation in your legs (which leads to amputations).
What should my cholesterol levels be?
Everyone is different, and the same levels do not apply to all patients. It is important to go over your cholesterol levels with your healthcare provider. Your provider will take into consideration your risk factors before giving you cholesterol level goals. You should strive for bad cholesterol (LDL) levels less than 100, and good cholesterol (HDL) levels greater than 60. Your triglyceride levels should be less than 150. You should achieve these goals with dietary changes and exercise if possible. Your healthcare provider will set your personal goals if you need medication to lower your cholesterol levels further.
What is bad cholesterol?
Low-Density Lipoprotein (LDL) is usually called “bad” cholesterol because it is the component that delivers the necessary amount of cholesterol to the tissues through the body. When it is found in high levels, it begins depositing cholesterol in the arteries around your body. These deposits lead to thickening and hardening of the arteries that is called atherosclerosis which leads to poor circulation, heart attacks, strokes, and kidney disease. LDL and “bad” cholesterol is a vital part of life, but it is important to keep it in the appropriate ranges. Ask your healthcare provider what your personal goals should be before starting medication.
What is good cholesterol?
High-Density Lipoprotein (HDL) is usually called the “good” cholesterol because it is used in reverse transport. This means that HDL actually removes cholesterol deposits, and it brings the cholesterol molecules back to the liver to be detoxified and reused. It is thought that high levels of HDL can reverse atherosclerosis or thickening of the blood vessels. Most healthcare providers will tell you that there is not a maximum level for HDL. You should strive for the highest levels possible. The best stimulator for HDL is sustained aerobic exercise (the cardio setting on most exercise equipment).
What are triglycerides?
Triglycerides are another type of fat that floats in your blood stream. Your body breaks down fats in your stomach, and they are absorbed as triglycerides. High triglycerides may mean you just ate a fatty meal. However, if you had your blood drawn while you were “fasting” and had not eaten for 8 hours, high triglycerides mean that your liver is turning the extra calories you eat into fats to store throughout your body. From recent studies, triglycerides have not been implicated in causing heart disease, but they are a marker of cardiovascular risk. If triglyceride levels rise above 500, you are at increased risk of developing Acute Pancreatitis which causes excruciating abdominal pain for several days.
How do I get evaluated for high cholesterol?
This is a simple blood test that can be drawn in the office. It helps to be fasting when you check your cholesterol level. Fasting means that you cannot eat or drink anything for 8 hours before your blood draw. You may drink water, black coffee, and you should take your medicine (except insulin and some diabetes medications).
There is advanced cholesterol testing that some offices provide which looks into more detail than the basic cholesterol panel. It looks at your individual proteins that carry around the cholesterol molecules. Without these proteins, cholesterol molecules would not mix in the blood stream. It would look like oil and water in a bottle. The cholesterol proteins (lipoproteins) are important because some proteins are specific markers found in heart disease. Some proteins are very small, dense, and “sticky.” These proteins are able to “stick” to blood vessel walls and create plaques. As the plaques harden, they have an increased likelihood of rupturing which causes heart attacks and strokes. Overall, thickening of the arteries via plaque deposits is called “atherosclerosis.”
How do I treat high cholesterol?
There are multiple ways to lower bad cholesterol levels and raise good cholesterol levels. The most important treatment regimen is a healthy lifestyle. Eating a healthy well-balanced diet (fruits, vegetables, fiber, fish, etc) can lower cholesterol levels tremendously. Avoiding known sources of bad fats is paramount: Processed foods, fast foods, and fried foods.
Exercise helps burn fat, and it lowers bad cholesterol (LDL) levels. Exercise is the best stimulator of good cholesterol (HDL) production. The best exercise is cardio or fat-burning exercise. This is low to moderate intensity, sustained activity. Examples of “cardio” exercises are jogging, brisk walking, swimming, water aerobics, and bicycling 10-15 mph. Your goal should be getting your heart rate above 100 and sustain it for a minimum of 20 minutes. The more you exercise – the better! You should start off slow and work your way up, increasing your exercise amount by about 10% each week.
Various medications help lower bad cholesterol (LDL) levels, raise good cholesterol (HDL) levels, improve particle sizes, etc.
Statins: Statin drugs have been the staple for cholesterol medicine. These medications are called “Statins” because all of the drug names in the class end in “statin.” For example: Simvastatin (Zocor), Atorvastatin (Lipitor), Rosuvastatin (Crestor), etc. Statins lower bad cholesterol, improve small, dense particles, and lower inflammation (hs-CRP levels). They are excellent medications and have a vast amount of evidence to prove their effectiveness. Common side effects include upset stomach, muscle aches, and fatigue. If you experience these side effects, voice your concern to your provider. You should try several different statins before you abandon them altogether because of their profound amount of evidence that shows benefit.
Niacin: Niacin has had proven benefit since the 1980’s. It reduces bad cholesterol (LDL) levels, but its claim to fame has been the ability to improve good cholesterol (HDL) levels. Few medications have shown benefit to good cholesterol levels. Niacin is also the only drug that has the potential to improve Lp(a) levels. Many people cannot tolerate Niacin because of its major side effect: “flushing” or “hot flash.” The flushing is caused by a raise in prostaglandin levels which cause dilation of the blood vessels throughout your entire body. There are various ways to improve this side effect. You should discuss your options with your healthcare provider. Your healthcare provider may recommend taking aspirin before taking your Niacin, or your provider may recommend a reduced-flush formulation. IMPORTANT: Do NOT take flush-free niacin because it does NOT have cholesterol reducing properties. Flush-free niacin is called “Nicotinamide.” We have a reduced-flush Niacin formulation at Austin Family Medicine Associates that is safe to take and is well tolerated.
Omega-3s, Fish Oils, Krill Oils, Vascepa: Omega-3 fatty acids are essential “healthy” fats that your body needs. Our body is not able to produce these healthy fats, so it is important to get them from our diet (or take the supplement). Omega-3 fats reduce inflammation and triglyceride levels. Fish sources are better than plant sources of Omega-3. Fish contain DHA and EPA which are the best Omega-3 fats while plant sources of Omega-3s usually only contain ALA which is not as potent because ALA is a precursor fat that is only partially converted to DHA and EPA. Vascepa is a prescription Omega-3 that is an EPA-only medication, hence their name VascEPA. It is the more costly Omega-3, but their studies are showing promising improvements to heart attacks and death. Not all fish are created equal. Although all fish contain Omega-3 fats, they all have different amounts. Fish that are high in Omega-3 fats are Salmon, Herrin, Mackeral, Sardines, Albacore tuna, etc. Note: You should not confuse Omega-3 fats with Omega-6 fats. Omega-6 fats are found in many oils, meats, and processed foods. They lead to high levels of inflammation, cholesterol, and chronic diseases.